Bris.J. Psychiat.(1976), iiz8, 181â€”3
Serum Creatine Phosphokinase in Acute Psychosis By SOM D. SONI Summary.
were graded by their degree of psychomotor activity. Serum creatine phospho kinase (CPK) levels were found to be related to the degree of psychomotor activity, irrespective of the diagnostic category. Retarded and withdrawn patients had normal serum CPK, but on their return to normal psychomotor activity the CPK levels tended to rise transiently. It appears that unphysio logical motor activity has a more direct relationship to the rise of serum CPK than motor activity per se.
hrraoDuc'rioN A number
had normal serum CPK at all times during
phosphokinase (i , 2,
Some authors have claimed the rise in CPK to be pathogenetically related to the basic aetiology of acute psychosis (@) and have even suggested it
disorders (4, g). Acute psychoses are often accompanied by considerable agitation and increased psychomotor activity. This paper reports the preliminary findings of a study relating the changes in serum CPK in acute psychoses to the degree of psychomotor activity. Fifty-four patients, suffering from a variety of psychotic disorders, participated in the study. Diagnoses psychiatric @
their stay in the hospital.
Blood samples were collected between break fast and lunch bi-weekly throughout the stay of the patient in the hospital and estimation of CPK
by the method
The patients showed a wide range of activity, from
I3 patients (6 depressive and 7 schizophrenic) through normal activity (8 patients) to severe overactivity, agitation and restlessness in i6 patients (agitated depression @, schizophrenia 7 and mania 4).
ward behaviour, and in particular the amount of psychomotor activity of each patient on a
In all, 18 of the
in serum CPK during their stay in hospital. On
by the groups, in the
admission 9 of the i6 patients with increased psychomotor activity (Grpup C) showed a rise of serum CPK, whereas only 2 from Group B and none from Group A showed a CPK level
present paper: Group A with minimal activity, marked withdrawal and psychomotor retarda tion; Group B with normal activity; and Group C with marked agitation, restlessness and
greater than 100 lU/l. In all but one of the patients with raised levels, the serum CPK fell as the patients recovered and the psychomotor activity subsided (Fig. i). In one patient serum
increased psychomotor activity. These were the patients who were rated on admission as having
encephalopathy, coronary heart disease or a his tory of alcoholism were excluded from the study.
were made by two independent assessors. A chart indicating the
five-point scale, was filled in daily nursing staff on the ward. Only three constituting 37 patients are discussed
Grades I, 3 and 5 activity respectively (see Table I). The remaining i patients, who showed either Grade 2 or Grade 4 activity,
patient remained overactive. In 7 patients with marked initial psychomotor retardation (Table I), 281
Time in weeks
in fact shown
at the time of
clinical recovery is difficult to explain, but it is a finding which has not been observed before.
may have been excessive and unphysiological when compared to the psychomotor activity 9
As the patient improved clinically and normal activity returned, the CPK levels rose very transiently above ioo lU/i, to return later to normal levels.
(@, 8), few
that is of importance [email protected]
Group A patients who showed rise ofserum CPK (lU/I)
2nd No.SexDiagnosisOn ActivityI
Depression Schizophrenia Depression
CPK Activity1stweek (IU/l)admission
7! 36 39
i6 62 5023
Psychomotor activity graded on a five-point scale: I. Marked
2. Some psychomotor
accompanied by a sustained rise in CPK. Adaptation will occur and serum CPK fall to normal. Thus athletes, who take more exercise than sedentary workers, do not have higher levels of serum CPK. This may be an explanation of
increased psychomotor activity is related to rise of serum CPK, this relationship is complex and not necessarily direct. It is the â€˜¿unphysiological'
that the source of raised
serum CPK is the skeletal muscle
the case from Group C in which CPK fell despite continued overactivity. This study has thus revealed that, whereas
DISCUSSIONAND CONCLUsIONS the finding
The cause of the transient rise of serum CPK
observation period and their relationship to psychomotor
levels in some retarded
Fio. i.â€”SerumCPK levels in i6 patientsfromGroup C changes
activity in psychoses and the rise in CPK (6, 8).
N2 of patientswith grade5 activity_ 16 showing
Thepresent study confirms thisrelationship.
tried to relate
Excessive â€˜¿unphysiological' activity is almost always accompanied by raised serum CPK (s),
3. Normal psychomotor activity. 4. Slight increase in psychomotor activity.
5. Marked increase in psychomotor activity with restlessnessand agitation.
BY SOM D. SONI
rather than motor activity per se. Since psycho motor activity appears to be related to the rise of serum CPK, the author feels that estima tion of serum CPK could not possibly be of value in the differential diagnosis of psychiatric disorders (6). One obvious problem in this type of study is the difficulty in quantitating the psychomotor activity. A method of accurately quantitating motor activity, using an EEG machine, has been evolved in this hospital, and work is now in progress for a second study incorporating this method.
2. COFFEY,J. W., HEATH, R. G. & Guscisw@re, A. F.
(â€˜97Â°)Serum creatine kinase, aldolase and copper in acute and chronic Biological P@ychiasry,2,331-9.
3. DUBO, H., P@iuc, D. C., PENNINOTON, R. J. T., KALBAG, R. M. & WALTON, J. N. (i@67)
in cases of stroke,
and meningitis. Lances,ii, 743-8. 4. GOSLING, R., Ksiutv, R. J., Oiure,J. E. & OWEN,G. (1972)
admitted psychiatric patients. British Journal of Psychiatry, 121, 351â€”5.
5. Giuiivmss, P. D. (i@66) Serum levels OfATP creatine phosphotransferase: the normal range and effect
of muscular activity. ClinicaChimicaAda, 53, 413â€”20.
6. H@uwmro, T. (â€˜974) Serum creatine kinase in acute
The author wishes to thank the nursing staff and Dr T. J. Rajapaksa for their help and cooperation. His thanks are also extended to Mrs P.JarViS and Mrs C. Bond
for their help in preparationof the paper and to Mr B. Lancaster for allowing the use of the pathological laboratory.
H. & K@ino,
& Mow@ia,R. (1970) Enzymaticactivity after exercise:
study of psychiatric
and their aa, 390-7.
9. â€”¿ â€”¿ (197o) Muscle abnormalities in acute psychoses. ArchivesofGeneralP@hiatrj, 2@,@Ã§8i-go.
RIPERINGE5 I . BENOZON, A., Hippius,
psychosis. British Journal ofP@ychiatrj, 525, 280-5.
7. MELW.R, H. Y. (i@6@)Muscle enzyme release in acute psychosis. Archivesof GeneralP@ychiatry,as,
H. (i p66)
change in the serum using psychotropic drugs.
Journal ofXervous and Mental Disease, 143, 369-76.
ofLaborator, and Clinical Medicine, 6g, 696-705.
Som D. Soul, M.D., Ph.D., M.R.C.P., M.R.C.PSYCh., Consultant Psychiatrist, Prestwich Hospital, Prestwich, Manchester, M25 7BL (Received 28 February5975)
Serum creatine phosphokinase in acute psychosis. S D Soni BJP 1976, 128:181-183. Access the most recent version at DOI: 10.1192/bjp.128.2.181
References Reprints/ permissions You can respond to this article at Downloaded from
This article cites 0 articles, 0 of which you can access for free at: http://bjp.rcpsych.org/content/128/2/181#BIBL To obtain reprints or permission to reproduce material from this paper, please write to [email protected]
/letters/submit/bjprcpsych;128/2/181 http://bjp.rcpsych.org/ on September 7, 2017 Published by The Royal College of Psychiatrists
To subscribe to The British Journal of Psychiatry go to: http://bjp.rcpsych.org/site/subscriptions/